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Abstract:

In Brief:

Considering a women’s risk of cardiovascular disease, dementia, osteoporosis, and family history must be used to guide decisions for elective oophorectomy and ovarian conservation at the time of benign hysterectomy.

Abstract:

In Brief:

In young postmenopausal women receiving estrogen therapy, there is no evidence for early coronary harm and the possibility of a decrease in coronary risk, but there may be a small increase in the risk of ischemic stroke. The hypothesis that there are different mechanisms explaining this difference, with thrombotic mechanisms predominantly explaining ischemic stroke risk.

Abstract:

In Brief:

Epidemiological data and systematic studies in nonhuman primates suggest that subclinical as well as clinically identified premenopausal ovarian dysfunction, regardless of cause, may predispose women to the precocious development of coronary artery atherosclerosis. These observations suggest that efforts to prevent coronary heart disease in postmenopausal women should begin during the premenopausal years.

Abstract:

In Brief:

The epidemiologic data on postmenopausal hormone therapy and the risk of breast cancer may reflect effects on preexisting tumors. It is possible that exposure to a combination of estrogen and progestin causes greater differentiation of preexisting tumors with earlier detection and better outcomes.

Abstract:

In Brief:

The initial analysis and interpretation of the prematurely terminated hormone therapy arms of the WHI were fatally flawed. Subsequent WHI publications in fact demonstrate that benefit: risk is favorable in direct relationship to proximity of menopause or decade of age. The NIH needs to recognize and address this misdirection in science.

Abstract:

In Brief:

Breast cancer occurs following the accumulation of a very large number of aberrant mutations which occur spontaneously as immature stem cells undergo rapid mitosis during breast development, or are passed from one cell generation to another as cells continue to divide. The role of sex hormones is to control the rate of mitosis, but neither estrogens nor progesterone appear to induce oncogenic mutations.

Abstract:

In Brief:

Observational studies suggest that menopause hormone therapy prevents coronary heart disease, whereas randomized clinical trials have not confirmed a cardioprotective effect. This commentary addresses possible methodologic and biologic explanations for the discrepancy and describes a new trial (the Kronos Early Estrogen Prevention Study) designed to address several of the unresolved questions.

Abstract:

In Brief:

The rationale for returning to progestin-free hormone treatment for menopause is becoming increasingly clear. Recent trials of low and ultra-low estrogen monotherapy regimens are promising in this regard.

Abstract:

In Brief:

The morbidity and mortality that can result from failing to identify and treat women at increased fracture risk are considerable. This article will explore the question of whether osteopenia, a subclinical state of osteoporosis, should be diagnosed and treated before it transitions into osteoporosis.

Abstract:

In Brief:

Beneficial effects of topical progesterone creams are controversial and have not been studied well. Although serum progesterone levels achieved with topical progesterone creams are low and not consistent with a secretory endometrium, antiproliferative effects of progesterone creams on the endometrium have been reported. Effects of topical progesterone creams on the endometrium should not be based on serum progesterone levels but on histologic examination of the endometrium.